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Your mother resists in-home helpers, insisting you can wait on her. Your frail father won't stop driving. Your aunt denies the need for a personal care aide, in spite of her unwashed hair and soiled clothes. Your grandmother refuses to move to an assisted living facility "because it's full of old people."

Sound familiar? Nothing is harder for a family caregiver than an elder loved one who refuses needed help. "This is one of the most common and difficult caregiving challenges that adult kids face," says Donna Cohen, Ph.D. a clinical psychologist and author of "The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders."

Before pushing your mother too hard to accept help, try to understand her fears about aging, says Cohen: "Many older people see themselves as proud survivors. They think 'I've been through good times and bad, so I'll be fine on my own.' Plus, they don't believe their children understand the physical and emotional toll of age-related declines."

A senior in the early stages of cognitive impairment may be the most difficult to deal with. "Your angry father or agitated mother is aware of this miserable change in their brain they don't quite understand," Cohen adds. Calm reassurance will help them cope with a frightening loss of function.

It's normal for family caregivers to experience rage, helplessness, frustration and guilt while trying to help an intransigent older loved one, says Barbara Kane, co-author of "Coping with Your Difficult Older Parent: A Guide for Stressed-Out Children." "You may revert to the same coping mechanisms you had during adolescent power struggles with your parent -- screaming, yelling or running out of the room," she says. "You need to understand what parental behaviors trigger your emotional response and realize you have other choices." (And Kane advises considering seeing a therapist yourself if necessary to deal with a difficult parent.)

Here are nine strategies to help you overcome the objections of a recalcitrant loved one:

1.Start Early

Ideally, families have relaxed conversations about caregiving long before a health crisis. Look for opportunities to ask questions like, "Mom, where do you see yourself getting older?" or "How would you feel about hiring a housekeeper or driver so you could stay home?"

2.Be Patient

Ask open-ended questions and give your loved one time to answer, says Care.com Senior Care advisor Mary Stehle, LCSW. "You can say, 'Dad, what's it like to take care of Mom 24 hours a day?'." But be warned: Conversations may be repetitive and tangential, veering off-topic. It may take several talks to discover the reason your mother, a meticulous housekeeper, has fired five aides in a row is simply that they neglected to vacuum under the dining room table.

3.Probe Deeply

Ask questions to determine why an elder refuses help -- then you can tailor a solution, says Kane. "Is it about a lack of privacy, fears about the cost of care, losing independence or having a stranger in the house?" says Kane. To build trust, listen with empathy and validate rather than deny your loved one's feelings. (Learn more about starting a conversation about care with your parent)

4.Offer Options

If possible, include your parent in interviews or in setting schedules, says Stehle. Let them choose certain days of the week or times of day to have a home health aide come. Emphasize an aide will be a companion for walks, concerts, museum visits and other favorite activities.

5.Recruit Outsiders Early

"Sometimes it's easier for a parent to talk to a professional rather than a family member," says Cohen. Don't hesitate to ask a social worker, a doctor or nurse, a priest or minister -- even an old poker buddy -- to suggest your parent needs help.

6.Prioritize Problems

Make two lists, says Cohen, one for your loved one's problems and another for the steps you've already taken -- and where to get more help. "If you don't categorize your efforts, caregiving becomes this huge weight," says Cohen. Writing it down and numbering by priority can relieve a lot of stress.

7.Use Indirect Approaches

If your father has dementia, offering less information may be more effective at times, suggests Stehle. "You could let your parent know the aide is someone very helpful who can take your father on walks, fix him meals, and help him throughout the day. You don't need to explain every aspect of care the aide will provide before the relationship has been formed. This may make your loved one feel less threatened."

8.Take it Slow

Weave a new aide in gradually, says Kane. Start with short home visits or meet for coffee, then bring the aide along to the doctor's a few weeks later. "You leave early on some pretext, letting the aide accompany your parent home."

9.Accept Your Limits

As long as seniors are not endangering themselves or others, let them make their own choices, says Cohen. "You can't be at your parent's side all the time. Bad things can happen, and you can't prevent them," she says. "You need to accept limits on what you can accomplish and not feel guilty." It may sound unfeeling, but maybe going a day or two without meals is just the reality check an elder needs to welcome a badly needed helping hand.

"You cannot stop the changes of time, but you can modify lifestyle and activity as you age, and it is good to know that help is available to maintain the efficiency of your healing system." -- Dr. Andrew Weil

The United States is on the brink of a longevity revolution. By 2030, the number of older Americans will have more than doubled to 70 million, or one in every five Americans. A 1997 longevity and retirement study revealed that 41 percent of people now working feel it is at least somewhat likely that they will live to age 85, 23 percent feel somewhat likely they will live to age 90, and even 15 percent feel it is at least somewhat likely they will live to age 95. The growing number and proportion of older adults places increasing demands on the public health system and on medical and social services.

Health, financial and lifestyle choices can enhance the quality of an individual's later years and create a life in balance.

Financial Issues

Adequate income and assets are of critical importance to virtually all dimensions of well-being in later life. Experts estimate that retirees will need, on average, 70 percent of their pre-retirement income, and lower earners will need 90 percent or more to maintain their standard of living when they stop working. Social Security pays the average retiree about 40 percent of pre-retirement earnings if you retire at age 65. How well you understand your options for managing money and how well you have planned will be the most critical factors in determining your financial well-being as you grow older.

Maintaining Your Health

Great improvements in medicine, science and technology have enabled today's older Americans to live longer and healthier lives than any previous generation. Yet many Americans fail to make the connection between undertaking healthy behaviors today and the impact of these choices later in life. Research has established that there are distinct advantages to physical exercise, both aerobic and weight-bearing. Individuals should design a program that is right for them. Moreover, screening programs can lead to preventive measures and early treatment interventions that can substantially reduce the impact of illnesses among older people. Diet is just as important. Nutritional status influences the progress of many diseases, and studies have shown that good nutritional status can reduce length of hospital stay, contributing to a life in balance.

Lifestyle Choices

Living quality lives as Americans grow older is defined almost entirely by individual financial planning, followed by some level of acknowledgment of good health practices. Other lifestyle issues are rarely included in discussions related to longevity and aging gracefully. Lifelong learning, volunteerism, care giving, leisure pursuits, second and third careers, and transportation involve issues which routinely impact on the lives of many Americans. However, most people do not readily identify that decisions made in these areas are an integral part of preparing for their future.

Chronic diseases exact a particularly heavy health and economic burden on older adults due to associated long-term illness, diminished quality of life, and greatly increased health-care costs. Although the risks of disease and disability clearly increase with advancing age, poor health is not an inevitable consequence of aging.

Age-Related Depression

Mental disorders experienced by older adults may differ from those experienced by younger people, which can make accurate diagnosis and treatment difficult. For example, an older person who is depressed may be more likely to report physical symptoms such as insomnia or aches and pains rather than feelings of sadness or worthlessness. It is also important to note that many physicians and other health professionals may not provide effective mental-health care because they receive inadequate training in the diagnosis and treatment of age-related depression in older adults.

Mental disorders represent a grave threat to the health and well-being of older adults. Older adults have the highest rates of suicide in the U.S., and while they represent only 13 percent of the population, individuals ages 65 and over account for 20 percent of all suicides. White men ages 85 and older are especially vulnerable with a suicide rate six times greater than that of the general population. Mental disorders can also negatively affect the ability of older people to recover from other health problems. Heart attacks are five times more likely to be fatal for a person who is depressed. The risk of death for nursing-home residents with major depression is 60-percent higher than for residents who do not have this mental disorder.

Being "down in the dumps" over a period of time is not a normal part of growing old. But it is a common problem, and medical help may be needed. For most people, depression can be treated successfully. "Talk" therapies, drugs, or other methods of treatment can ease the pain of depression. There is no reason to suffer.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more likely to be dismissed as crankiness or grumpiness. Depression can also be tricky to recognize. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for high blood pressure or heart disease. Depression can happen at the same time as other chronic diseases. It can be hard for a doctor to diagnose depression, but the good news is that people who are depressed can get better and live a life in balance with the right treatment.

Alzheimer's Disease

The occurrence of Alzheimer's disease (AD) is not a normal development in the aging process. Alzheimer's disease is characterized by a gradual loss of memory, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impaired judgment and ability to plan, and personality changes. Over time, these changes become so severe that they interfere with an individual's daily functioning, resulting eventually in death. While the disease can last from 3 to 20 years after the onset of symptoms, the average duration is 8 years.

Alzheimer's disease affects as many as 4 million Americans. Most people diagnosed with AD are older than 65. However, it is possible for the disease to occur in people in their 40s and 50s. Recent research has shown links between some genes and AD, but in about 90 percent of cases, there is no clear genetic link. Early and careful evaluation is important because many conditions, including some that are treatable or reversible, may cause dementia-like symptoms. Examples of such treatable medical conditions are depression, nutritional deficiencies, adverse drug interactions and metabolic changes.

Much of the illness, disability and death associated with chronic disease is avoidable through known prevention measures. Key measures include practicing a healthy lifestyle (e.g., regular physical activity, healthy eating and avoiding tobacco use) and the use of early detection practices (e.g., screening for breast, cervical and colorectal cancers, diabetes and its complications, and depression).

Life Plannning

A life course planning approach maximizes access to information and realistic options so people can: maintain the best possible health status and address long-term care needs that they or family members might have; establish long-term economic security and contribute to pensions, savings, investments and public benefits; secure living arrangements that accommodate any special needs; engage in productive, satisfying activities including volunteer work, employment, and community participation which are expressions of active aging; and being an informed consumer. Through life course planning, everyone - from secure, middle-aged people to older Americans who tend to be at greatest risk - can make responsible, informed personal choices in anticipation of their later years.

Regular Exercise

Regular exercise is a preventive measure that will enhance quality of life for everyone. Older adults have some special considerations.

Some interesting facts:

•Exercise can help older people feel better and enjoy life more, even those who think they're too old or too out of shape.

•Most older adults don't get enough physical activity.

•Lack of physical activity and poor diet, taken together, are the second largest underlying cause of death in the U.S. (Smoking is the #1 cause.)

•Regular exercise can improve some diseases and disabilities in older people who already have them. It can improve mood and relieve depression, too.

•Staying physically active on a regular, permanent basis can help prevent or delay certain diseases (like some types of cancer, heart disease, or diabetes) and disabilities as people grow older.

Plan on making physical activity a part of your everyday life, and plan on aging gracefully. Do things you enjoy. Go for brisk walks. Ride a bike. Dance. And don't stop doing physical tasks around the house and in the yard. Trim your hedges without a power tool. Climb stairs. Rake leaves. Live a life in balance.

Twenty years ago, my grandmother sold her eight-bedroom home in Atlantic City and moved to an apartment in Philadelphia. “Take this tablecloth,” she begged, “this mirror...the china set...this crystal...” And the list went on. “I don’t have room,” I responded. “It’s not my taste...I already have two of those...” I had good reasons for saying “no.”

Now I regret those decisions. It’s not that I have grown to like the things she offered; it's that I see my actions as self-centered and immature. I was thinking about myself when I should have been thinking about her.

Ironically, I now work as a specialist in senior moves and, consequently, see this scene and others like it reenacted every day. With the perspective and objectivity that comes perhaps only to the professional or the outsider, here are some tips for adult children who are faced with helping their parents move:

Try to replicate the old environment as much as possible.

Your parents will be experiencing a lot of change; it will be comforting to have some things stay the same. Photograph each shelf in the china closet, the arrangement of pictures on walls and items on bureaus. The photographs will help you recreate the feel of the former residence with amazing accuracy and speed.

Let your parents’ emotional and physical comfort guide the process. Your parents’ priorities may be different from yours. If books were very special to them, they may need to determine what will happen to the volumes not going with them before they are willing to focus on other issues. Attempting to force your parents to proceed in a sequence that doesn’t address their priorities may result in your winning the battle but losing the war.

Your parents’ perspective may differ from yours as well. They may prefer old and worn objects to newer items that are in much better condition. Seemingly insignificant items may be loaded with personal meaning and memories, while objects of great material value may be less important. Allow them to make the decisions.

Accept their gifts.

Your parents may want to give you items, including some you may not be happy to receive. Take them anyway. Store the items in your basement if you must, but accept them graciously. Knowing that cherished objects are with family can bring comfort and peace of mind to your parents.

Be tactful.

Often poor health and failing eyesight result in housekeeping practices that are less stringent than they once were. Tactfully offer to clean things as you sort through or pack. Avoid making your parents feel bad about the home they are leaving.

Focus on sorting, not packing.

Preparing for a senior move is a major organizational challenge. It’s not uncommon to have items going to your parents’ new home, to an adult son in Maine, a daughter in Illinois, a granddaughter in Arizona, a niece in Texas, the church bazaar, the Salvation Army, the neighborhood consignment shop, and the township dump. Attics, basements, garages, closets and cupboards....there may be forty years of belongings to sort through. Many people feel overwhelmed.

It’s here more than anywhere else that you are needed. Helping your parents sort and organize their belongings is the single most important thing you can do to reduce the stress of moving, ensure a smooth move, and save money in the long run.

Let your parents say good-bye.

When you work with your parents, keep sorting sessions brief (two–three hours at most). Constant decision-making is emotionally exhausting. Accept that some days you will accomplish less than you had hoped.

The sorting process brings up lots of memories. Stories and reminiscing are natural. It’s all right to be directed in your goal, but let your parents enjoy their recollections. It’s part of saying good-bye.

Be realistic about how much time you can devote to the moving process.

Allow 40-60 hours for the packing and unpacking (once you have acquired all the packing materials), and at least that much time for the sorting process, spread out over several months if possible. If your time is limited, use it to help your parents prepare for their move, and obtain professional help for the pack and unpack.

Concentrate on the big picture.

Senior moves are stressful for the entire family, as adult children assume new responsibilities in addition to their own homes, jobs and families. Conflicts sometimes develop between siblings over who bears which portion of the burden, or over the disposition of material items. As you work with your parents and siblings, keep three objectives equally in mind—caring for your parents, taking care of yourself, and keeping the family intact.

I know my friend Alice is dealing with a lot these days! She has taken on the responsibility of caring for her Dad with Alzheimer’s. I really want to help my friend but I don’t know how. I know that caregiving can be a very stressful job. What can I do?

If this sounds familiar here are a few suggestions. With the holiday season surrounding us there are plenty of ways you can offer to help.

1.Organize a Gift Wrapping Party- Get a few friends together and let Alice know that you will be coming over Saturday afternoon to wrap all of her gifts. Ask if she needs you to pick up paper or other supplies.

2.Organize a Holiday Decorating Party- You know your friend loves to have her house decorated for Christmas but she is just too exhausted to do it. Tell her your group will be coming over to take care of everything and you will return after Christmas to take everything back down.

3.Make calls to local churches and other organizations to find out what other resources may be available to help her with the on-going care of her Dad. In some of the local churches in my area there are Caregiver Day out programs much like the Mom’s Day Out Programs. A Caregiver is able to drop off a family member with Alzheimer’s for a few hours with trained volunteers who have a program planned. This gives the caregiver a much needed break. Check to see what is available in your community.

4.Offer to stay with her dad for a hour or two a week- This will give your friend a much needed break. She can run an errand, get her nails done or just take a walk. If she feels uncomfortable leaving the house tell her you will come in and entertain Dad while she takes a long hot bubble bath.Sometimes it’s hard for a caregiver to let go and allow someone else to take over. She may feel protective of her dad with Alzheimer’s.

5.Call from the grocery store to see if she needs anything- Picking up that bottle of milk or loaf of bread is one less thing she has to worry about. Chances are if she knows you are already at the store she will be more likely to let you help by picking up a few things than if you offered to make a special trip for her.

6.Call and ask how she is doing – And then listen.Don’t try to fix her problems or offer solutions just listen.Listening is the most valuable gift you can give your friend.